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Insurance Utilization Review Jobs in Rochester, NY

DePaul

Quality Management Specialist I (DACC)

Rochester, NY · On-site

$23.20 - $24.70/hr

Responsible for Utilization Record Review functions to include Individual record audits, admission ... Medical Insurance, Dental Insurance, Vision Insurance, Life Insurance, Generous PTO & Paid Holidays ...

DePaul

Quality Management Specialist I

Rochester, NY · On-site

$23.20 - $24.70/hr

Responsible for Utilization Record Review functions to include Individual record audits, admission ... Medical Insurance, Dental Insurance, Vision Insurance, Life Insurance, Generous PTO & Paid Holidays ...

DePaul

Quality Management Specialist I

Rochester, NY · On-site

$23.20 - $24.70/hr

Responsible for Utilization Record Review functions to include Individual record audits, admission ... Medical Insurance, Dental Insurance, Vision Insurance, Life Insurance, Generous PTO & Paid Holidays ...

DePaul

Quality Management Specialist I (DACC)

Rochester, NY · On-site

$23.20 - $24.70/hr

Responsible for Utilization Record Review functions to include Individual record audits, admission ... Medical Insurance, Dental Insurance, Vision Insurance, Life Insurance, Generous PTO & Paid Holidays ...

DePaul

Quality Management Specialist I (DACC)

Rochester, NY · On-site

$23.20 - $24.70/hr

Responsible for Utilization Record Review functions to include Individual record audits, admission ... Medical Insurance, Dental Insurance, Vision Insurance, Life Insurance, Generous PTO & Paid Holidays ...

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Insurance Utilization Review information

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$21

$41

$68

How much do insurance utilization review jobs pay per hour?

As of Jul 7, 2026, the average hourly pay for insurance utilization review in Rochester, NY is $41.72, according to ZipRecruiter salary data. Most workers in this role earn between $32.98 and $47.93 per hour, depending on experience, location, and employer.

What are the most common challenges faced by Insurance Utilization Review professionals?

One common challenge in Insurance Utilization Review is balancing the need for cost-effective care with the clinical needs of patients, which often requires careful analysis and decision-making. Professionals in this role frequently navigate complex medical records, strict policy guidelines, and collaborate with healthcare providers who may advocate strongly for particular treatments. Managing challenging conversations while maintaining professionalism and ensuring timely determinations are also a regular part of the role. Developing expertise in these areas can make the job both demanding and rewarding, while building a strong foundation for career growth within healthcare administration.

What are the key skills and qualifications needed to thrive in the Insurance Utilization Review position, and why are they important?

To thrive in Insurance Utilization Review, you generally need a strong background in healthcare or nursing, an understanding of medical terminology, and analytical thinking skills, often supported by an RN license or relevant clinical experience. Familiarity with utilization management software, coding systems like ICD-10, and knowledge of regulatory requirements (such as Medicare or Medicaid) are important. Strong communication, attention to detail, and problem-solving abilities help professionals excel when interacting with providers and insurers. These skills are essential to ensure appropriate care is authorized while maintaining regulatory compliance and cost-effectiveness.

What is an Insurance Utilization Review job?

An Insurance Utilization Review job involves evaluating medical treatments and services to determine if they are necessary, appropriate, and covered by a patient's insurance plan. Professionals in this role review medical records, treatment plans, and insurance policies to ensure compliance with guidelines and cost-effectiveness. They work closely with healthcare providers, insurance companies, and patients to facilitate approvals or appeals. The goal is to balance quality patient care with cost containment in the healthcare system.

What are the most commonly searched types of Insurance Utilization Review jobs in Rochester, NY? The most popular types of Insurance Utilization Review jobs in Rochester, NY are:
What are popular job titles related to Insurance Utilization Review jobs in Rochester, NY? For Insurance Utilization Review jobs in Rochester, NY, the most frequently searched job titles are:
What job categories do people searching Insurance Utilization Review jobs in Rochester, NY look for? The top searched job categories for Insurance Utilization Review jobs in Rochester, NY are:
What cities near Rochester, NY are hiring for Insurance Utilization Review jobs? Cities near Rochester, NY with the most Insurance Utilization Review job openings:
Insurance Utilization Review jobs near you
Infographic showing various Insurance Utilization Review job openings in Rochester, NY as of July 2026, with employment types broken down into 1% As Needed, 72% Full Time, 23% Part Time, and 4% Contract. Highlights an 90% Physical, 1% Hybrid, and 9% Remote job distribution, with an average salary of $86,774 per year, or $41.7 per hour.
Quality Management Specialist I (DACC)

Quality Management Specialist I (DACC)

DePaul

Rochester, NY • On-site

$23.20 - $24.70/hr

Part-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 11 days ago

Job description

Overview
The Quality Management Specialist works with the Quality Management Department to provide the highest achievable quality of services to the individuals we serve. The Quality Management Department defines best practices, identifies strengths in service delivery and provides structure through which problem identification and resolution can occur. Quality Management Specialists at DePaul will assist in the establishment of outcomes, indicators and monitoring for Quality Assurance purposes. The QM Specialist will assist in the analysis of data gathered to implement change as needed for improvement of services.
Why work for DePaul?
  • Make a positive difference in someone's life
  • Supportive work environment
  • We value diversity
  • Opportunity for professional development and career advancement
  • Excellent benefits and competitive wages
  • Pay range for this position is $23.20-$24.70/hour based on experience

Responsibilities
  • Implementation of the Quality Management Plan within the corporation.
  • Incident Management - review incident reports and provide feedback and recommendations(site-specific). Responsible for incident investigations and determining trends for reporting and follow-up consultation and training.
  • Responsible for Utilization Record Review functions to include Individual record audits, admission reviews, continued stay reviews and discharge reviews.
  • Participate in gathering and preparation of necessary statistics for Quality Management / Improvement reports.
  • Participate and support the implementation of Risk Management activities throughout the corporation.
  • Review and follow-up to consumer, family members and other providers' concerns / complaints.
  • Involved in facilitation of client feedback for quality improvement purposes. Responsible for the Resident Satisfaction Surveys.
  • Responsible for the Family Satisfaction Survey and other surveys as deemed necessary.
  • Involved in agency-wide Quality Improvement functions as determined appropriate.
  • Involved in performance-based outcomes activities as determined appropriate.
  • Provide support to the Quality Management Vice-President, Quality Management Director and Quality Management Specialist II as requested.
  • Participate in DePaul's overall Quality Management planning.
  • Performs all other duties as assigned.

Qualifications
  • Registered Nurse or Licensed Practical Nurse with 3 years of experience in long-term care; OR Bachelor's degree with 3 years of experience in long-term care.
  • Adult care experience preferred.
  • Valid NYS driver's license - travel required. Must meet DePaul's Clean Driving Record Policy

Benefits
This position is eligible for the following for the following benefits: Medical Insurance, Dental Insurance, Vision Insurance, Life Insurance, Generous PTO & Paid Holidays, 403B with Employer Match, robust Employee Assistant Program, Staff Recognition Program and Employee Discount Program.
DePaul is an equal opportunity employer that values diversity. All employment is decided based on qualifications, merit, and program need.

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